In America;The Republican Way

By BOB HERBERT

Published: October 27, 1995

As Republicans in Congress continue to make great progress in their mission to dismantle the Medicare and Medicaid programs, keep in mind that this odious effort has nothing to do with any desire to reform the health-care system, or to improve the quality of services available to the poor, the elderly, the young or the disabled.

The suffering of real people is not a concern of politicians whose moral universe is represented in its totality by the dollar sign. The assault on Medicare and Medicaid is, purely and simply, a naked grab for hundreds of billions of dollars earmarked for the care of people unfortunate enough to have fallen ill.

The money is being snatched for two purposes, neither of which has anything to do with health care. The Republicans need the cash to help make good on their dubious promise to balance the Federal budget in seven years, and to help pay for tax cuts that are not only unnecessary but (especially in light of the balanced-budget promise) foolish.

In a statement criticizing Republican plans to seize $270 billion that would have gone to Medicare, the American College of Physicians said: "Premiums will double by 2002, straining patients who already spend one dollar in five on medical expenses. The average income of the over-65 population is about $18,000. Congress cannot expect these patients to bear out-of-pocket costs as high as 25 percent of their incomes by some estimates. What happens is that patients forgo medical care. This legislation will reverse the gains in the health status of the elderly that Medicare has achieved in its 30-year history."

The statement continued, "Reimbursement will be cut deeply in all delivery environments -- both managed care and fee-for-service -- affecting the ability of H.M.O.'s, individual physicians, hospitals, nursing homes and home health-care agencies to provide care."

Can't you just hear Bob Dole and Newt Gingrich having a good cynical chuckle over these naive concerns?

The Republicans' plans for Medicaid -- the health-care safety net for the poorest Americans, and for nearly a quarter of the nation's children -- were put in perspective by Hillary Rodham Clinton. "Medicaid is a lifeline, literally, for millions of children and families in America," she said. "Ripping out this lifeline, ripping up this safety net, is not the American way. It is not the American way to deny infants the shots they need to stay healthy. It is not the American way to deny treatment to children who are disabled or desperately ill."

It is, however, the Republican way. Health professionals believe the party's proposals for Medicaid will result, by 2002, in 9 million to 12 million people -- including children, pregnant women, senior citizens and people with disabilities -- being left without any health-care coverage at all.

There is also a widespread and well-grounded fear that the combined loss of funding from Medicare and Medicaid will force some hospitals in inner cities and isolated rural areas to shut down entirely. Such hospitals, because of the populations they serve, typically receive more than half of their patient-care revenues from Medicare and Medicaid.

Many people will go without care. But many others, especially those who are the most severely sick or injured, and those who have delayed treatment as long as they could, will be thrown in an increasingly haphazard and inefficient way on public facilities that will be increasingly ill equipped to deal with them.

The result will be both tragic and expensive in the extreme. No money will be saved. None. In the guise of fiscal prudence, the Republicans are foisting a fool's parlay on the public. They are pushing a policy that will lose both money and lives.

"We will really, truly have to cut services," said Karen Heller of the Greater New York Hospital Association. "Hospitals in New York City would lose about $13 billion over seven years. We are very dependent on Medicare and Medicaid."

As the dollars begin to disappear, various money-losing services will go with them. Clinics will close. Research and teaching will be cut back. Access to physician care in general will be reduced.